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目的:探讨超声斑点追踪成像技术评价右室间隔部起搏与右室心尖部起搏对左心室心肌收缩时序及同步性影响的应用价值。方法:获取右室间隔起搏组(9例)、右室心尖起搏组(15例)、正常对照组(13例)心尖四腔观、二腔观、左心室长轴观,胸骨旁左室短轴二尖瓣水平、乳头肌水平和心尖水平的图像,测量左室各节段收缩期纵向应变达峰时间(TsL),胸骨旁短轴观测量收缩期径向应变达峰时间(TsR)和径向应变率达峰时间(TsrR),并计算节段达峰时间的标准差(TsL-SD,TsR-SD,TsrR-SD)及任意两节段间达峰时间最大差值(TsL-d,TsR-d,TsrR-d)作为左室收缩不同步性指标。通过分析收缩期纵向应变达峰时间,评估各组内左室机械收缩时序。结果:右室心尖起搏组纵向与径向收缩不同步性指数高于正常对照组及右室间隔起搏组,差异均具有统计学意义(P<0.05),而右室间隔起搏组与正常对照组纵向与径向收缩不同步性指数差异均无统计学意义。右室间隔起搏组左室收缩时序与正常对照组类似,右心室心尖起搏组的左心室壁收缩时序较正常对照组发生改变,左室整体收缩达峰时间较正常对照组及右室间隔起搏组延迟,多数节段差异具有统计学意义(P<0.05)。结论:右室心尖起搏较右室间隔部位起搏左室心肌在纵向、径向上均存在显著的收缩不同步,提示与异常的电机械激动顺序相关。斑点追踪成像技术可用于右室不同部位起搏对左室心肌收缩同步性及收缩时序影响的评价。
OBJECTIVE: To evaluate the value of ultrasound speckle tracking imaging in assessing the timing and synchrony of left ventricular systolic contraction in right ventricular septal pacing and right ventricular apical pacing. Methods: Right ventricular pacing group (n = 9), right ventricular apical pacing group (n = 15), normal control group (n = 13) The images of mitral valve, papillary muscle and apical level were taken to measure the peak time of systolic longitudinal strain (TsL) in each segment of the left ventricle and the peak systolic radial strain (TsR (TsL-SD, TsR-SD, TsrR-SD) and the maximum difference of peak time between any two segments (TsL-d , TsR-d, TsrR-d) as an indicator of left ventricular systolic asynchrony. By analyzing the peak systolic longitudinal strain time to assess the left ventricular mechanical contraction within each group. Results: The index of asynchrony in longitudinal and radial contraction of right ventricular apical pacing group was higher than that in normal control group and right ventricular septal pacing group (P <0.05) There was no significant difference in asynchrony index between longitudinal and radial contractions in normal control group. Right ventricular septal pacing group left ventricular systolic sequence similar to the normal control group, right ventricular apical pacing group left ventricular wall contraction sequence than the normal control group changes, the peak time of the left ventricular systolic peak compared with the normal control group and right ventricular septum Delayed pacing group, most of the differences were statistically significant (P <0.05). CONCLUSIONS: Right ventricular apical pacing has significant systolic and asynchrony in both longitudinal and radial directions compared with right ventricular septal pacing, suggesting a correlation with abnormal electromechanical activation. Speckle tracking imaging can be used to assess the systolic synchrony of systolic and systolic timing in different parts of the right ventricle.